Citation Nr: 18146587 Decision Date: 10/31/18 Archive Date: 10/31/18 DOCKET NO. 16-01 642 DATE: October 31, 2018 ORDER Entitlement to an effective date of March 26, 2008 for the grant of service connection for posttraumatic stress disorder (PTSD) is granted. Entitlement to a rating of 70 percent, but no more, for PTSD is granted on and after March 26, 2008, subject to the laws and regulations governing the payment of monetary benefits. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is granted. FINDINGS OF FACT 1. The Veteran submitted a request to reopen his previously denied claim of service connection for depression on March 26, 2008. VA denied the claim of service connection for depression on its merits in an October 2008 rating decision. The Veteran appealed that decision and the claim remained on appeal until VA granted service connection for PTSD in an August 2014 rating decision. 2. It is at least as likely as not that the Veteran has had PTSD since March 26, 2008. 3. Entitlement to service connection for PTSD arose on March 26, 2008, the day VA received the Veteran’s claim. 4. The Veteran’s PTSD, throughout the period on appeal, has been manifested by occupational and social impairment with deficiencies in most areas, but not total occupational and social impairment. 5. The Veteran’s service-connected disabilities have met the percentage requirements for the award of a schedular TDIU, and the evidence indicates that the nature and severity of these disabilities prevent him from performing gainful employment for which his education and occupational experience would otherwise qualify him. CONCLUSIONS OF LAW 1. With resolution of reasonable doubt in the Veteran’s favor, the criteria for entitlement to an effective date of March 26, 2008, for the grant of service connection for PTSD have been met. 38 U.S.C. §§ 5101, 5107, 5110 (2012); 38 C.F.R. §§ 3.102, 3.400 (2017). 2. With resolution of reasonable doubt in the Veteran’s favor, on and after March 26, 2008, the criteria for a disability rating of 70 percent, but no higher, for PTSD have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1-4.14, 4.21, 4.126, 4.130, Diagnostic Code 9411 (2017). 3. With resolution of reasonable doubt in the Veteran’s favor, the criteria for the award of a TDIU have been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Air Force from December 1970 to March 1974, including service in the Vietnam War. These matters are on appeal from an August 2014 rating decision. As described in further detail below, the Veteran’s attorney has contended in a March 2017 statement that the Veteran is unemployable as a result of his service-connected PTSD. VA most recently denied the Veteran’s TDIU claim in September 2012. The Board finds that the issue of entitlement to a TDIU has been raised by the March 2017 statement in connection with the claim on appeal for an increased rating for the Veteran’s PTSD. See Rice v. Shinseki, 22 Vet. App. 447 (2009). Neither the Veteran nor his attorney have raised any issue with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). 1. PTSD – Effective Date The Veteran asserts that he should be granted an effective date earlier than August 20, 2013 for service connection for PTSD. Unless specifically provided otherwise by statute, the effective date of an award for compensation benefits based on (1) an original claim, (2) a claim reopened after final adjudication, or (3) a claim for increase, is the date VA received the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400; Lalonde v. West, 12 Vet. App. 377, 382 (1999) (holding that the effective date of service connection is not based on the date of the earliest medical evidence demonstrating a causal connection, but rather, on the date the application was filed with VA). The Veteran has specifically requested an effective date of March 26, 2008. Therefore, although the Board acknowledges that the Veteran has submitted several prior claims for service connection for a psychiatric disability, the earliest of which VA received on July 17, 1984, it is unnecessary for the Board to consider the issue of entitlement to an effective date earlier than March 26, 2008. VA received the Veteran’s request to reopen his previously denied claim of entitlement to service connection on March 26, 2008. VA denied the claim on the merits of the underlying service connection issue in an October 2008 rating decision. The Veteran appealed and the claim remained on appeal until VA granted service connection in an August 2014 rating decision. The question, then, is whether entitlement to service connection arose before or after March 26, 2008. Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). In July 2010, the Veteran was afforded a psychological examination by the Tennessee Disability Determination Section. The examiner, T. R. M.A., diagnosed PTSD and the report was reviewed and co-signed by Dr. H. M, a licensed psychologist. The Veteran was afforded a VA examination on August 20, 2013. The examiner diagnosed PTSD. This examination is the basis for the currently assigned effective date. The Veteran was afforded an addendum opinion on the issue of onset in June 2014 by the VA examiner who examined the Veteran in August 2013. The examiner opined that the Veteran’s PTSD had “recently developed,” but the sole rationale for this was that there had been no previous PTSD diagnosis. As stated above, an examiner diagnosed PTSD in July 2010. A medical opinion based on an inaccurate factual premise has limited, if any, probative value. Reonal v. Brown, 5 Vet. App. 458, 461 (1993). In addition, the Board notes the examiner’s observation that the Veteran had had “numerous previous psychiatric diagnoses” and that their symptoms were “encompassed by” the current PTSD diagnosis. The examiner specifically did not opine that the prior diagnoses were incorrect or inappropriate, but did not provide a rationale for this opinion. The Veteran was afforded an additional addendum opinion by a different VA examiner in August 2014. This examiner also opined that the Veteran’s PTSD was of “relatively recent origin,” based solely on “the fact that previous examiners have considered the disorder and ruled it out.” Because this examiner’s opinion is based on the same inaccurate factual premise as the June 2014 opinion, it is also of limited, if any, probative value. The record contains a diagnosis of PTSD three years before the current effective date and some indication that the symptoms of the Veteran’s PTSD encompass those of the psychiatric disabilities with which the Veteran was previously diagnosed. This raises the possibility that the Veteran’s PTSD had an even earlier onset but was misdiagnosed as other psychiatric disabilities. Two VA examiners have opined that the Veteran’s PTSD was of recent onset, but those examiners’ opinions are of, at most, limited probative value. In light of the totality of the circumstances, and after resolving all reasonable doubt in the Veteran’s favor, the evidence of record supports a finding that it is at least as likely as not that the Veteran’s PTSD had its onset on or before March 26, 2008. For that reason, the Board finds that the Veteran is entitled to an effective date of March 26, 2008 for service connection for PTSD. 2. PTSD – Increased Rating The Veteran contends that his PTSD warrants a higher rating than that currently assigned. It is rated under 38 C.F.R. § 4.130, Diagnostic Code 9411, for PTSD, with a 50 percent rating on and after August 20, 2013. Service connection has been granted above for the period from March 26, 2008 to August 19, 2013, but no disability rating has been assigned for that period. Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate Diagnostic Codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4 (2017). Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. “Staged” ratings are appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). Given the nature of the present claim for a higher initial evaluation, the Board has considered all evidence of severity since the effective date for the award of service connection. Fenderson v. West, 12 Vet. App. 119 (1999). Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. Under 38 C.F.R. § 4.130, psychiatric impairment is rated under the General Rating Formula for Mental Disorders. 38 C.F.R. § 4.130 provides that a 50 percent rating is warranted for occupational and social impairment with reduced reliability and productivity due to such symptoms as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbance of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. 38 C.F.R. § 4.130. A 70 percent evaluation is warranted for occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful situations (including work or a worklike setting); and inability to establish and maintain effective relationships. Id. A 100 percent rating is in order when there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of close relatives, occupation, or own name. Id. When evaluating a mental disorder, VA must consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the claimant’s capacity for adjustment during periods of remission. See Vazquez–Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013). VA shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner’s assessment of the level of disability at the moment of the examination. 38 C.F.R. § 4.126 (a). When evaluating the level of disability from a mental disorder, VA will consider the extent of social impairment, but shall not assign an evaluation solely on the basis of social impairment. 38 C.F.R. § 4.126 (b). In May 2008, during a phone call to VA, the Veteran said he had “nothing to live for” and should kill himself. He then said that, if the police arrived, he “should just have them go ahead and shoot” him. The Veteran was referred for a mental health evaluation. During the evaluation, which took place on the same day, the Veteran denied making any suicidal statements. He reported two to three panic attacks per day but was vague in describing them. He reported worsening depression and constant anxiety. He reported having no friends because they no longer wanted to be around him and that he was not close to his family. He denied any history of suicidal acts, self-harm, or violence to others. On examination, he was alert and oriented, there were no hallucinations or illusions, his thought processes were normal and coherent, he had no unusual thought content, and his memory was intact. The treatment provider found that the Veteran posed no significant danger to himself or others. During a June 2008 VA treatment appointment, the Veteran reported occasional crying spells and denied any desire to harm himself or others. He reported a frequent desire to stay home and ascribed this to his anxiety. VA treatment records report the Veteran’s symptoms as generally similar through the remainder of 2008 and 2009. During a May 2010 VA treatment appointment, the Veteran was brought in for a risk assessment due to visible agitation and anger. He reported significant stress and symptoms of depression but that he had calmed down and was no longer distressed. He also reported decreased frustration tolerance, including becoming angrier about minor stressors. During a VA treatment appointment two days later, the Veteran reported increased stress, anger, and difficulty getting along with others, including what the treatment provider characterized as “bad thoughts” about the people with whom he was angry. He reported worsening depression and that this was limiting his activities. He reported that he had been married twice, with the most recent marriage ending in 2001, and had one adult daughter with whom he had a “so-so” relationship. He reported getting along reasonably well with his family but denied being close with them. He ascribed this distance to past “bad” behavior, including anger problems. He reported no current hallucinations or illusions but that he used to have them. In July 2010, the Veteran was afforded a psychological examination by the Tennessee Disability Determination Section. He reported that he no longer drove but did not say why. He denied any difficulty finding his way around in familiar territory or performing self-care chores. His reported living alone and his hygiene was adequate. There were no unusual movements. He reported that depression limited his ability to cook, perform routine household chores, and shop independently, adding that he sometimes did not care about these things. He reported being easily irritated in public and often losing his temper. He denied any recent suicidal ideation but reported a history of auditory and visual pseudo-hallucinations. He reported problems with concentration and memory, including problems with task completion and misplacing frequently used objects. On examination, he denied experiencing hallucinations or mood instability, his reality contact appeared adequate, and he evidenced no overt signs of psychotic, delusional, or paranoid thinking. The examiner found that the Veteran’s PTSD and depression were likely to produce marked restriction in his ability to sustain concentration and performance and demonstrate adequate persistence in his social interactions and in his ability to remember and carry out instructions on a day to day basis. The examiner also found that the Veteran was likely to experience at least moderate restriction in the area of adaptation with regard to his being able to adapt to changes in his work environment. During a VA treatment appointment later in July 2010, the Veteran reported increased confusion, difficulty with concentration, anxiety, panic attacks, and interpersonal conflict. He ascribed some of this to recent vascular surgery. The treatment provider ascribed the Veteran’s increased anxiety and irritability to physical stressors and concern about those stressors, including vascular surgery. In January 2011, the Veteran had a verbal altercation with a pharmacist in which he said that he should go home and “do them a favor” by killing himself. He was referred for a psychiatric appointment. The Veteran ascribed this statement to “complete anger” and denied that he would ever try to kill himself. The treatment provider found that the Veteran was not suicidal or homicidal and was not a danger to himself or others. During an April 2011 hearing before the Board with regard to his claim for service connection for PTSD, the Veteran testified that he had lost both spouses and four jobs due to his psychiatric symptoms. During a June 2011 VA treatment appointment, the Veteran reported increased irritability, anxiety, and mood swings. The Veteran was afforded a VA examination in September 2011. The examiner found the Veteran’s history unreliable, but did not explain which parts of it were unreliable or why. The Veteran reported continuing to live alone and reported losing his most recent job due to absenteeism. The examiner noted that the Veteran had “caused commotion at VA hospital when dissatisfied with mental health provider – resulted in being taken to ER by police for examination when he threatened suicide after that mental health visit.” The examiner later noted that this “commotion” was in 2009, which is not the year noted for the incidents above; it is not clear whether this description refers to one of the incidents referenced above or a separate incident. The Veteran also reported that his last encounter with the police was “a couple of years ago when he was going to blow up his home and police came and escorted him away.” The examiner listed the Veteran’s symptoms for rating purposes as depressed mood, anxiety, suspiciousness, chronic sleep impairment, impaired judgment, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances including work or a worklike setting, inability to establish and maintain effective relationships, obsessional rituals which interfere with routine activities, and impaired impulse control such as unprovoked irritability with periods of violence. The examiner characterized the Veteran’s overall level of functional impairment as occupational and social impairment with reduced reliability and productivity, which is consistent with a 50 percent rating. During a December 2012 VA treatment appointment, the Veteran reported paranoid ideation and an obsession with cleanliness. The treatment provider characterized the Veteran’s paranoia as chronic and low-level. The Veteran has submitted a March 2013 examination by a private psychologist. The Veteran reported that he lived alone but got help from his brother and nephew with household tasks. He also reported being forgetful and defensive. He reported losing his most recent job due to physical problems and “outbursts.” He also reported increased social withdrawal and a history of emotional outbursts when dissatisfied with others. The examiner listed the Veteran’s symptoms for rating purposes as depressed mood, anxiety, near-continuous panic or depression, chronic sleep impairment, mild memory loss, difficulty understanding complex commands, impaired judgment, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty adapting to stressful circumstances, inability to establish and maintain effective relationships, impaired impulse control, and intermittent in ability to perform activities of daily living including maintenance of minimal personal hygiene. The examiner characterized the Veteran’s overall level of functional impairment as occupational and social impairment with deficiencies in most areas, which is consistent with a 70 percent rating. The examiner opined that the severity of the Veteran’s symptoms had been consistent since March 26, 2008. The examiner added that the Veteran’s symptoms would have a “major impact upon social and occupational functioning,” including in terms of remembering and carrying out more than simple instructions and procedures, concentrating upon assigned tasks, functioning independently in complex situations, rendering judgments on more than simple work-related tasks, having the ability to initiate activity and follow through with more than simple tasks, and interacting with supervisors, coworkers, and the general public in situations that are more than minimally stressful. The examiner further opined that the Veteran would frequently miss work, need to leave early, or be unable to stay focused to complete simple, repetitive tasks due to his psychiatric symptoms and would frequently decompensate when subjected to normal workplace stressors. In July 2013, the Veteran reported for a VA examination and there was some confusion as to whether he had been scheduled for that date. The Veteran began to shout at the examiner while hitting himself in the head with a fist. The examiner had another provider call VA police, who said that they had encountered the Veteran before. The examination was rescheduled. The Veteran then went to the emergency room and said that he had been referred there due to suicidal ideation; the examiner clarified that there had been no opportunity to make any such assessment and that the Veteran had not expressed suicidal ideation during their interaction. The Veteran was admitted for inpatient psychiatric treatment. Later that day, the Veteran reported that he had spoken “out of rage,” that he had a tendency to “lose” himself, and that he did not mean what he had said. The treatment provider characterized the Veteran as “pleasant and manipulative.” He reported having no friends, which he ascribed to others finding him arrogant. The Veteran denied any history of suicide attempts or violence to others. He did not endorse overt auditory or visual hallucinations but reported sometimes hearing a noise like a gunshot when about to go to sleep. In August 2013, on the date of his discharge from hospitalization, the Veteran reported difficulty with anger, including punching holes in walls. He also reported obsessive thoughts and compulsive behavior, as well as occasionally hearing the “voices of God.” The Veteran was afforded an additional VA examination on August 20, 2013. The Veteran reported that he continued to live alone and that he had a distant relationship with his adult daughter. He denied having any hobbies. He reported that he had not worked since 2008, other than short-term odd jobs through the Social Security office and a seven-month housekeeping assignment as part of a work program for unemployed veterans. He also reported that he was prone to becoming physically and verbally aggressive with others when angry. He reported feeling depressed more often than not for the past two years. He reported suicidal thoughts at times but denied current suicidal ideation. He reported crying spells “all the time” as well as feelings of guilt, hopelessness, and helplessness. He also reported occasional auditory hallucinations in the form of hearing someone call out his name when no one is present. The examiner listed the Veteran’s symptoms for rating purposes as depressed mood, anxiety, suspiciousness, chronic sleep impairment, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, suicidal ideation, and neglect of personal appearance and hygiene. The examiner opined that the Veteran’s psychiatric condition did not, by itself, impair his ability to engage in physical or sedentary employment. The examiner characterized the Veteran’s overall level of functional impairment as occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, which is consistent with a 30 percent rating. During a September 2013 VA treatment appointment, the Veteran reported general improvement in symptoms, but continued irritability. During a June 2014 VA treatment appointment, the Veteran reported participation in church-related activities. During a November 2015 VA treatment appointment, the Veteran did not report any prominent mood symptoms. The Veteran has submitted a January 2017 statement by his younger brother, who reported that the Veteran’s symptoms included decreased motivation and focus, often becoming angry and easily frustrated, flashbacks and nightmares, as well as “serious disorientation” in the form of “not knowing where he was or how he came to be there.” He also opined that the Veteran’s PTSD “causes him to be unable to form or sustain effective relationships in his life and there is no way he could handle even the simple stresses of work without becoming overly frustrated and losing focus, as well as his temper.” He also reported that the Veteran was increasingly withdrawn and isolated, staying home most of the time. The Veteran has also submitted a February 2017 examination by a private psychologist. The Veteran reported that he continued to live alone and to be socially isolated and withdrawn. He also reported that his brother helped him with food shopping and that he struggled with chores. He reported showering once or twice a week. He also reported visual hallucinations in the form of seeing shadow figures when no one was present. The examiner listed the Veteran’s symptoms for rating purposes as depressed mood, anxiety, suspiciousness, panic attacks weekly or less, near-continuous panic or depression, chronic sleep impairment, mild memory loss, impairment of short and long term memory, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty adapting to stressful circumstances, inability to establish and maintain effective relationships, persistent delusions or hallucinations, and neglect of personal appearance and hygiene. The examiner characterized the Veteran’s overall level of functional impairment as occupational and social impairment with deficiencies in most areas, which is consistent with a 70 percent rating. The examiner further opined that the Veteran would frequently miss work, need to leave early, or be unable to stay focused to complete simple, repetitive tasks due to his psychiatric symptoms and would respond in an angry manner without actually becoming violent when subjected to normal workplace stressors more than once a month. The examiner opined that the Veteran “cannot sustain the stress from a competitive work environment or be expected to engage in gainful activity due to his PTSD,” specifically sleep impairment, memory issues, inconsistent mood, anxiety, and poor interpersonal skills. Based on the evidence described above, the Board finds that, affording the Veteran the benefit of the doubt, his psychiatric symptoms and overall disability picture warrant an evaluation of 70 percent for PTSD throughout the period on appeal. The record contains evidence of suicidal ideation, obsessional rituals, near-continuous panic or depression, impaired impulse control, spatial disorientation, neglect of personal appearance and hygiene, difficulty in adapting to stressful circumstances, and inability to establish and maintain effective relationships. Because these are nearly all of the criteria demonstrating occupational and social impairment with deficiencies in most areas, the Board finds that Veteran’s symptoms most nearly approximate those that warrant a 70 percent rating. 38 C.F.R. §§ 4.7, 4.130, Diagnostic Code 9411. The Board does not, however, find the criteria for a 100 percent evaluation are more nearly approximated by the Veteran’s symptoms at any point during the period on appeal. The record contains evidence of persistent delusions or hallucinations and intermittent inability to perform activities of daily living. In addition, self- harm is contemplated by the 100 percent criteria. Bankhead v. Shulkin, 29 Vet. App. 10 (2017). However, even the constant presence of some symptoms listed in the criteria for a 100 percent rating is insufficient because the overall guiding criterion for a 100 percent rating is that both total occupational and total social impairment be present. 38 C.F.R. § 4.130; see, e.g., Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013). In this case, the Veteran’s symptoms have not been shown to be so severe that he has both total occupational and total social impairment. The Board acknowledges that, in this decision, it has found the Veteran to be unemployable due to his service-connected disabilities, but the Veteran has been able to maintain some personal relationships, specifically with his adult daughter, brother, and nephew. The Board acknowledges that these relationships are sometimes strained or distant and that there is nothing in the record to indicate that he has been able to form social relationships outside of his family during the period on appeal, but that is reflected in the current 70 percent rating for “deficiencies in most areas,” including inability to establish and maintain effective relationships. Because the Veteran is not totally socially impaired, a 100 percent rating is not warranted. The Board also notes that many of the Veteran’s reported symptoms throughout the period on appeal are included among those specifically listed in the General Rating Formula for Mental Disorders, pursuant to which a 70 percent disability rating has been assigned. See 38 C.F.R. § 4.130. Importantly, the Board notes that symptoms noted in the rating schedule are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular disability rating. See Mauerhan v. Principi, 16 Vet. App. 436 (2002). In other words, symptoms comparable to those listed in the General Rating Formula could be considered in evaluating the Veteran’s extent of occupational and social impairment. Accordingly, in this case, the Board finds that the existence and severity of the Veteran’s psychiatric symptoms are adequately contemplated by the 70 percent rating criteria. As noted above, many of the symptoms are specifically listed in the General Rating Formula for Mental Disorders, and the others are common psychiatric symptoms that-while not specifically listed-are comparable indicators of the type of occupational and social impairment contemplated in the Rating Formula. The Board has also considered the Veteran’s assertions regarding his psychiatric symptoms, which he is competent to provide, as well as those of his brother. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). The lay evidence is also credible. The symptoms described in those lay statements comport with the 70 percent rating that has now been assigned; for example, the Veteran’s brother’s statement is the basis for the Board’s finding that the Veteran’s symptoms include spatial disorientation. However, these lay statements do not provide any basis upon which to assign a higher rating because they do not reflect total social impairment. In sum, the Board finds that, resolving reasonable doubt in the Veteran’s favor, his impairment due to PTSD has been most consistent with a 70 percent disability rating throughout the period on appeal. 3. TDIU VA will grant a total disability rating when the evidence shows that a veteran is precluded, by reason of service-connected disabilities, from securing and following substantially gainful employment consistent with his education and occupational experience. 38 C.F.R. §§ 3.340, 3.341, 4.16. The regulations provide that if there is only one such disability, it must be rated at 60 percent or more; and if there are two or more disabilities, at least one disability must be rated at 40 percent or more, and sufficient additional disability must bring the combined rating to 70 percent or more. Disabilities resulting from common etiology or a single accident or disabilities affecting a single body system will be considered as one disability for the purposes meeting the requirement of one 60 percent disability or one 40 percent disability. 38 C.F.R. § 4.16 (a). Because the Veteran’s PTSD is now rated 70 percent disabling throughout the period on appeal, the criteria for consideration of a schedular TDIU are met, even without considering the Veteran’s nine other service-connected disabilities. The Board has discussed the evidence regarding occupational impairment caused by the Veteran’s PTSD in the context of the increased rating claim above. The Board finds the February 2017 private examiner’s finding that the Veteran “cannot sustain the stress from a competitive work environment or be expected to engage in gainful activity due to his PTSD” to be compelling and supported by the evidence of record. The Board therefore finds that the evidence is at least evenly balanced as to whether the Veteran’s service-connected disabilities have rendered him unemployable under the applicable regulations. As reasonable doubt must be resolved in favor of the Veteran, entitlement to a TDIU is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. D. Martz Ames Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Ryan Frank, Counsel